ICD-10 Post Grace Period

September 6, 2016

With the end of the ICD-10 one-year grace period set to expire soon, some healthcare stakeholders are pondering what kind of spike the industry might see in claims rejections once review contractors get back into the practice of citing coding specificity as a reason for denials as of October 1, 2016.

It would, however, be a stretch to say that many are exactly fretting about the end of ICD-10 flexibility given the past year’s rather uneventful transition to the new medical classification system.

The October 2015 release of the 10th revision to the International Classification of Diseases that brought the procedure and diagnosis index from 13 thousand codes to 68 thousand codes was met with ample demand for a longer provider preparation period. ICD-10 flexibility was CMS’ compromise and, if early research is any indication, healthcare providers pulled the migration off without a revenue cycle hitch. Key performance indicators (KPIs) like days cash on hand and net days in accounts receivable showed virtually no change in ICD-9 versus ICD-10 comparisons.

While the proverbial ICD-10 sky didn’t fall as many feared it might, that’s not to say that healthcare organizations haven’t seen a few hiccups as the industry acclimates to the new coding system.

The expanded code set brings an unprecedented degree of exactitude to the system, introducing differentials that account for body site, laterality, medical severity and initial versus subsequent versus sequela encounters. That granularity has resulted in productivity loss as medical coders traverse the deeper classification index in pursuit of the proper code.

Fifty percent of the 5,500 altogether new ICD-10 codes are musculoskeletal related and 25 percent are fracture related, which means radiology departments face additional learning curves under the new system. One outsourced coding provider recently cited a 25 percent permanent productivity loss among the organization’s radiology coders.

Another factor slowing coders down is the dig for clinical documentation. As HIM thought-leader and “ICD-10 Whisperer” Brad Justus puts it, “Quality coding starts with quality documentation. Proper physician education and complete, accurate documentation is a must. A coder can only code what is in the chart.” Clinical documentation improvement (CDI) initiatives are a natural next step for many providers moving forward.

Justus also champions the importance of routine internal chart and coder audits to help organizations identify recurring problems before they become bigger issues that may result in claims rejections and revenue disruption. ICD-10 best practices suggest tracking KPIs by month and by payer type (Medicare, Medicaid, commercial) across a variety of account types (inpatient, outpatient, same-day, ER, etc.).

While medical coders certainly have their hands full getting accustomed to ICD-10, strong demand for HIM and CDI professionals is promising for those working in or entering the field. At present, the shortage of experienced ICD-10 coders is driving growth in third-party coding adoption and computer assisted coding automation. Considering the sector’s key role at the ground floor of population health management initiatives, it’s safe to say the HIM stage is set for immense growth.